Posted tagged ‘stress and anxiety’

Can’t sleep with a big event the next day

August 15, 2019

Q:  When I have something important the next day like a job interview, seems I toss and turn for hours.  But if I have nothing going on I sleep like a rock.  This has caused me to miss some good opportunities, so how do I deal with it?

A: It’s common and normal to feel some general anxiety and increased stress levels in advance of a job interview, or a test, or an important upcoming assignment.  Such stress increases, providing they’re not excessive, can help improve one’s ability to perform, and so can actually be desirable.

But in terms of sleep, you are right.  The increased stress and anxiety does commonly affect sleep.

Maybe it would help you to know that sleep is happening, you probably just don’t realize it.  Sleep state misperception is very common.  It may not feel like it, but if you allow yourself to just rest comfortably in bed with your eyes closed you will in all likelihood drift off and benefit.

Perhaps more importantly, a significant body of evidence shows even if we don’t feel like our best because of a restless night, our performance does not necessarily suffer.  This is true both cognitively and physically.  Pretty much every starting pitcher in game 7 of the World Series can tell you that!

If you ever feel overwhelmed by stress or anxiety, or if it becomes excessive and unremitting, then counseling can go a long way to help you get it back under control.

But if you are experiencing normal levels, then know it’s OK to let go the worry and be confident you will be just fine, even if it doesn’t feel that way.  The difference is largely in perception, not performance.

Negative thoughts prior to some big event are just one example of the many worrisome issues that can disrupt sleep.  For more help, consider using cognitive restructuring, one of the core methods in CBT sleep training.

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How long does CBT sleep training take to work?

December 19, 2018

Q:  I’m now on week 2 of CBT sleep training, using sleep restriction therapy, and find myself lying on the couch at night unable to sleep.  I’m stressed about using the methods because they don’t seem to be working and feel worse off than I was before.  How long before I can expect some improvement?

A:  First be sure you are using the full CBT sleep training program From your description, you may not be doing it right.

As part of the stimulus control method, you sleep only in your bed, never on the couch.

The idea is to reduce frustration by getting up and out of bed when you are too awake to sleep.  Watching TV or reading while sitting on the couch is OK, but you risk falling asleep if you let yourself lie down.  That then results in an unhealthy association of your couch as the only place you can fall asleep.

It’s very important you head back to bed when you begin to feel drowsy.  You may need to remind yourself of what drowsiness feels like — yawning, droopy eyelids, wandering thoughts, head nodding are all sure signs.  When you feel that, head back to bed and try sleep again.  Stimulus control supports and improves what you’re doing with sleep restriction.

Also be assured as you continue learning all the CBT methods, you’ll soon have the tools needed to effectively counter these negative, stressful thoughts.  These negative sleep thoughts are like the raw fuel that prolongs and perpetuates insomnia, so countering them is actually one of the most important keys to a permanent solution.

To answer your question, results are very individual.  Some people respond very quickly, within a week or two of first starting the methods.  For others it is slow but steady progress that can take months.  The good news is CBT sleep training methods help most people and the benefits tend to be lasting.

Bottom line is it’s very important to use all the CBT methods simultaneously within a structure. That’s the support a full CBT sleep training program gives you.

Use positive emotions to supercharge cognitive restructuring

July 24, 2017

Those practicing cognitive restructuring to improve sleep know how effectively it can counter and control negative sleep thoughts.  These persistent negative thoughts are often the raw fuel that prolongs and perpetuates insomnia.  But did you know you can in effect supercharge cognitive restructuring by adding a positive emotional trigger?

Cognitive restructuring — one of the core components of CBT sleep training — uses reason, rationality, and understanding to correct inaccurate and distorted thoughts about insomnia to something better, more realistic, and more supportive of better sleep.

But reason and rationality by themselves — while essential and important — don’t necessarily counteract the underlying feeling or emotion behind those inaccurate thoughts.

By intentionally adding a positive emotional component to the practice of cognitive restructuring, you may find your old negative and entrenched attitudes and beliefs about sleep begin lose their grip more quickly — to be replaced by positive and supportive beliefs that you create and control.   In the practice of CBT sleep training, this is one of many ways to take better control over your sleep performance.

The method we suggest in the Sleep Training System takes the normal CBT route of restructuring distorted sleep thoughts into better, more rational thoughts, but importantly adds a meaningful emotional trigger to that thought — specifically a feeling, but not just any feeling.

By associating a concept that triggers for you a good and positive emotion along with the restructured positive sleep thought, the benefit is enlarged and magnified.  The new and more complete positive thought can now more effectively counteract all the incessant negativity and stress insomniacs tend to associate with the idea of sleep.

As part of a comprehensive sleep improvement program, thinking your way to better sleep works naturally — and without drugs or side effects.  This process enables you to constructively address the true underlying root issue of insomnia that afflicts so many people — that seemingly nonstop barrage of worry and persistently negative thoughts about sleep.

How do I get off melatonin?

April 26, 2017

 

Q:  After years of use, melatonin no longer works for me — but I’m finding it hard to stop.  How can I avoid insomnia when I end it?  Is there a way to taper off without disrupting my sleep too badly?

A:  Good call for trying to get off this.  Melatonin is a non-prescription substance sometimes marketed as a “natural” alternative to sleeping pills, but in reality melatonin is a systemic hormone with unknown long term effects on the mind and body.

Over-the-counter sleep aids like melatonin are not recommended by the official clinical guidelines from the American Academy of Sleep Medicine because they have not been proven effective or safe for treating chronic insomnia.

Although the pineal gland produces melatonin naturally in the brain, supplemental melatonin is sometimes suggested by healthcare professionals for short term use while adjusting to jet lag, and for the blind who can not otherwise use light to naturally stimulate melatonin production.

If you have an underlying medical issue disrupting your sleep, melatonin might be worth considering for temporary use in lieu of a prescription medication with troublesome side effects.  Your best advice on this will come from a doctor who examines you and knows your medical history, contraindications, and any other issues.  In your case, a tapering strategy under the supervision of a healthcare professional is a good idea.

You can also help in effect stack the deck in your favor by adhering to a strong sleep supportive lifestyle as you make this transition. That means such things as a consistent sleep-wake schedule, exposing yourself to bright light immediately upon awakening, getting some natural sunlight during the day, avoiding bright light and screen time before bed, no or minimal napping, daily exercise, avoiding caffeine later in the day, and so on.

Be confident you’ll get all the melatonin you need from just living a healthy sleep supportive lifestyle.

Busting the myth of “I can’t sleep”

July 19, 2016

Q:  I want to sleep more than anything else, but just can’t.  Seems I lie in bed for hours and hours, and no matter what I do can’t fall asleep.  Any ideas?  I just want to sleep!

A:  First, let’s clarify. Yes you can sleep. The fact is you can’t not sleep, even if you tried.  Maybe you mean you can’t sleep when you want for as long you want, but in reality sleep at some point becomes irresistible for us all.

The experience of those with severe untreated obstructive sleep apnea demonstrates this fact well.  Those with untreated OSA can’t sleep for more than a few minutes at a time before waking themselves up, often gasping for air.  They may compensate by getting dozens if not hundreds of microsleeps throughout the night and often throughout the day — a potentially very dangerous situation for anyone with this condition who drives or operates machinery.  Microsleeps are of course a poor substitute for normal sleep, but it demonstrates how one way or another your mind and body will simply not be denied sleep, no matter what you do or don’t do.

The key is, of course, managing the inevitable sleep process for the best results.

The frustration you are expressing is understandable.  There is nothing quite like the agony of being dead tired in bed, wanting to sleep, but aggravated at our inability to do so when we want.

What we can’t do is try and force sleep. That tactic usually backfires as one becomes more alert, more frustrated, more angry at one’s inability to sleep. A frontal assault just doesn’t work.

There are better ways.

We suggest you’ve got to outflank this insomnia to beat it. Take at indirect approach. Outsmart it.

This is usually done by attacking insomnia at its true roots.  First, see a doctor to ensure you are either treating or have ruled out any underlying medical issues.  But don’t be surprised if you have none.  Most insomnia is not caused by a legitimate medical condition.  In that case, you may need to incorporate nonmedical strategies.

These typically include CBT sleep training methods. Such cognitive behavioral methods usually consist of some combination of stimulus control, sleep hygiene, consistent sleep timing, stress management, relaxation training, and control of anxiety.  Any of these issues, if not properly managed, can and will disrupt sleep.

Sleep is more than anything else a process of letting go.  Of not doing more than doing.  The process is the direct opposite of forcing.  But rest assured there is help, including effective methods that are entirely drug free.

Acknowledging the fact that yes in fact you can sleep may be an important first step in a permanent solution for you.  By controlling your thoughts, behaviors, and your environment you can in effect “stack the deck” in your favor for better sleep when and for how long  you want.

 

Don’t get stressed by sleep restriction

January 27, 2016

Q:  Falling asleep isn’t my problem, but I awaken typically at 2 or 3 a.m. then often cannot fall back asleep or it takes me what seems like hours to do so.  I’ve tried sleep restriction and cannot do it anymore because I get overly stressed by the idea of limiting my sleep.  Any other ideas to help me sleep better through the night?

A:  Sleep restriction therapy (SR) is one of the most effective ways to help consolidate sleep into one unbroken period, but if it causes you stress then it might be helpful to take a new and better approach.

In the Sleep Training System (STS), our approach is to modify the practice of sleep restriction therapy with the intent of reducing stress, while also gaining its significant benefits to counter insomnia and improve sleep.

SR is a key component in cognitive behavioral therapy specifically designed for insomnia (CBTI), and its benefit has been proven repeatedly by empirical science.  The method can be modified in a number of ways, however, so what might work for you is to re-think the idea of SR to work to your advantage.

SR is critically important because it sets and maintains a consistent pattern of sleep and wakefulness.  Your inherent sleep system thrives on this sort of regularity.  By establishing a consistent sleep-wake pattern, you accomplish many things.

Most important is the profound benefit of regulating your circadian rhythm, and synchronizing that to your homeostatic sleep drive.  Circadian rhythm and sleep drive are the two most important internal components controlling sleep.  Control these two to your advantage, and you are well on your way to better sleep permanently.

In the STS, we call this practice sleep timing.  Instead of thinking of this idea in a stressful way, we suggest re-conceiving it in a strategic way — one that supports a comprehensive effort to improve sleep.

Part of this strategy for better sleep is simply to get up at the same time every day.  Another part is limit any daytime napping to no more than 10 to 15 minutes.  A third and key part is to limit your time allowed in bed to more closely match how much you are actually sleeping each night.

This is where the restriction comes in, but if that idea causes you stress, throw out the idea of restriction.  Think of it instead as your strategy, your beneficial plan that enables you sleep better permanently.  Focus on the rich rewards that idea holds!

Indeed, a separate and supporting method we call “constructive imagination” in the STS enables you to re-think your old ideas about sleep and let go of the counter-productive negativity that is causing you stress.  The re-casting of your old, stressful ideas about sleep into new, better, more positive, and more accurate ideas is actually a key part of the solution.

In this sense, you literally think your way to better sleep, while sleep timing methods enable you to regulate and synchronize your physical sleep system.  The two methods synergistically combine in a potent and very powerful way.

Don’t give up on SR, sleep timing, or however you conceive of this practice, because it works.  By making this positive effort, by controlling what you can reasonably control, by letting go of the stress-producing negative thoughts about sleep, you may find your sleep naturally consolidates much more easily into one unbroken period.  This is exactly what the science tells us, as well as the experience of many satisfied STS users … and there is every reason to believe it will work for you too.

Waking up at the same times each night

May 15, 2015

Q:  For the past few nights I have been awakening at very close to the same times each night, about 1:30 a.m., 3:00 a.m., and 4:30 a.m.  Now I’m beginning to worry I’m getting locked into this pattern.  Is this kind of thing normal?

A:  Awakening at the exact same time for multiple nights is unusual, and likely coincidental.

However, if you keep a consistent sleep schedule, it might not be all that surprising to awaken at similar times each night.  That’s because our mind-body system generally works in roughly 90 minute sleep cycles, with 4 or 5 such cycles typically per night.  Each cycle consists of several predictable sleep phases, including deep or slow wave sleep, and REM (rapid eye movement), also known as dream sleep.  Each cycle normally ends with a REM dream phase, and that’s when sleep typically is lightest.

Even the best sleepers will awaken to some degree during the transition from one cycle to the next.  However, good sleepers usually fall right back asleep and by morning do not remember these transient awakenings.

Those with insomnia — who are often lighter sleepers anyway — tend to be awake longer during these sleep cycle transitions, and that’s when conditioned negative sleep thoughts and anxiety or stress from the previous day can hit hard.  Then it can understandably take longer than a few minutes to fall back asleep.

In the Sleep Training System, we counter this by using specific in-bed relaxation methods that can help you move naturally back to a drowsy state more conducive to falling  asleep.

As we age, we also tend to spend less time in the deepest sleep phases, and more time in what’s known as stage 2 sleep.  Stage 2 is true sleep, but lighter than the slow wave sleep phases.  Also, the elderly may reach a REM dream phase much faster than younger persons, sometimes entirely skipping preliminary phases.  These are just a couple of changes that often occur as we age.

So if you awaken in the night and can recall a vivid dream, it’s likely you’ve just completed one of these typical sleep cycles.  This kind of awakening is therefore normal, and by itself nothing to worry about.

You might benefit by becoming less of a clock watcher.  Some of us can become somewhat obsessed with checking the time when awakened in the night, but if that only works to remind you of how much sleep you’re losing, then your clock can become yet another conditioned cue that reinforces insomnia.

By using proven cognitive and behavioral methods for better sleep, you can help naturally strengthen your inherent sleep system to the point where these middle-of-the-night awakenings, while common and normal, are no longer bothersome.